Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/4985—Pyrazines or piperazines ortho- or peri-condensed with heterocyclic ring systems
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
  • A61K47/10—Alcohols; Phenols; Salts thereof, e.g. glycerol; Polyethylene glycols [PEG]; Poloxamers; PEG/POE alkyl ethers
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/26—Carbohydrates, e.g. sugar alcohols, amino sugars, nucleic acids, mono-, di- or oligo-saccharides; Derivatives thereof, e.g. polysorbates, sorbitan fatty acid esters or glycyrrhizin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0002—Galenical forms characterised by the drug release technique; Application systems commanded by energy
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/10—Dispersions; Emulsions
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
  • A61K9/50—Microcapsules having a gas, liquid or semi-solid filling; Solid microparticles or pellets surrounded by a distinct coating layer, e.g. coated microspheres, coated drug crystals
  • A61K9/5005—Wall or coating material
  • A61K9/5021—Organic macromolecular compounds
  • A61K9/5031—Organic macromolecular compounds obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyethylene glycol, poly(lactide-co-glycolide)
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
  • A61P31/12—Antivirals
  • A61P31/14—Antivirals for RNA viruses
  • A61P31/18—Antivirals for RNA viruses for HIV
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00

Definitions

• the present invention relates to long acting parenteral (LAP) formulations as well as methods of treating Human Immunodeficiency Virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) using the same.
• LAP long acting parenteral
• HAART highly active antiretroviral therapy
• salvage therapy includes at least two, and preferably three, fully active drugs.
• first-line therapies combine three to four drugs targeting the viral enzymes reverse transcriptase (RT) and protease (PR).
• RT reverse transcriptase
• PR protease
• One option for salvage therapy is to administer different combinations of drugs from the same mechanistic class that remain active against the resistant isolates.
• the options for this approach are often limited, as resistant mutations frequently confer broad cross-resistance to different drugs in the same class.
• Alternative therapeutic strategies have recently become available with the development of fusion, entry, and integrase (IN) inhibitors.
• resistance to all three new drug classes has already been reported both in vitro and in vivo.
• the present invention addresses the issue of non-compliance as well as the prevention of, or treatment of, HIV by formulating certain HIV inhibitor compounds, including the first compound, second compound, and/or third compound, as a Long Acting Parenteral (LAP) composition suitable for administration, for example, once per month, once every 2 months, once every 3 months, once every 6 months or once every 12 months.
• LAP Long Acting Parenteral
• a LAP composition of the present invention may comprise a pharmaceuticall acceptable excipient and a first compound of the structure:
• second compound of the structure:
• third compound of the structure:
• the first compound and second compound may comprise their isomer forms wherein the present invention provides a long acting parenteral (LAP) pharmaceutical composition comprising a pharmaceutically acceptable excipient and a first compound of the structure:
• LAP long acting parenteral
• a LAP pharmaceutical composition including the first compound, second compound, and/or third compound, or a pharmaceutically acceptable salt thereof.
• a method for the treatment or prevention of an HIV infection in a human having an HIV infection including administering to the human a LAP pharmaceutical composition including the first compound, second compound, and/or third compound, or a pharmaceutically acceptable salt thereof.
• a method for the treatment or prevention of an HIV infection in a human having an HIV infection including administering to the human a LAP pharmaceutical composition including the first compound, second compound, and/or third compound, or a pharmaceutically acceptable salt thereof.
• a LAP pharmaceutical composition including the first compound, second compound, and/or third compound, or a pharmaceutically acceptable salt thereof in HIV medical therapy.
• a fifth aspect of the present invention there is provided the use of the first compound, second compound, and/or third compound, or a pharmaceutically acceptable salt thereof in the preparation of a long acting parenteral medicament for use in the treatment or prevention of HIV infection in a human.
• Figure 1 depicts a plot of LAP Mean Concentration of the first compound versus time in hours of a LAP Rat PK study at 5 mg/kg and 20 mg/kg doses.
• Figure 2 depicts a plot of LAP Mean Concentration of the first compound versus time in hours of a LAP Dog PK study at 2.5 mg/kg and 5 mg/kg doses.
• Figure 3 depicts a plot of LAP Mean Concentration of the first compound versus time in hours of a LAP Rat (IM) PK study for different drug microparticle formulations
• the HIV Gag polyprotein precursor (Pr55Gag), which is composed of four protein domains - matrix (MA), capsid (CA), nucleocapsid (NC) and p6 - and two spacer peptides, SP1 and SP2, represents a new therapeutic target.
• Pr55Gag The HIV Gag polyprotein precursor
• MA protein domains - matrix
• CA capsid
• NC nucleocapsid
• SP1 and SP2 two spacer peptides
• Maturation converts the immature, donut-shaped particle to the mature virion, which contains a condensed conical core composed of a CA shell surrounding the viral RNA genome in a complex with NC and the viral enzymes RT and IN. Maturation prepares the virus for infection of a new cell and is absolutely essential for particle infectivity.
• Bevirimat (PA-457) is a maturation inhibitor that inhibits the final step in the processing of Gag, the conversion of capsid-SP1 (p25) to capsid, which is required for the formation of infectious viral particles.
• Bevirimat has activity against ART-resistant and wild- type HIV, and has shown synergy with antiretrovirals from all classes.
• Bevirimat users with Gag polymorphisms at Q369, V370 or T371 demonstrated significantly lower load reductions than patients without Gag polymorphisms at these sites.
• PCT/US2012/024288 "Novel Anti-H IV Compounds and Methods of Use Thereof ;
• Chinese PCT Application Nos. PCT/CN2011/002105 and PCT/CN2011/002159 “Propenoate Derivatives of Betulin”; and US Provisional Application No. 61/576,448, "Derivatives of Betulin".
• With each iteration of maturation inhibitor a need exists to optimize the polymorphism isolate coverage and achieve maximum potency while minimizing the protein shift. To date, no maturation inhibitor has achieved an optimal balance of these three properties.
• Such betulin derivatives include 4- (((3aR,5aR,5bR,7aR,9S, 11aR, 11 bR, 13aS)-3a-((R)-2-((4-Chlorobenzyl)(2-(dimethylamino) ethyl)amino)-1-hydroxyethyl)-1-isopropyl-5a,5b,8,8, 11 a-pentamethyl-2-oxo-3,3a,4,5,5a,5b, 6,7,7a,8,9, 10, 11 , 11 a, 11 b, 12, 13, 13a-octadecahydro-2H-cyclopenta[a]chrysen-9-yl)oxy)-2,2- dimethyl-4-oxobutanoic acid which is the "First Compound":
• the "second compound” is Cabotegravir, an HIV integrase inhibitor currently in development by GlaxoSmithKline as a long acting parenteral drug.
• the second compound is Cabotegravir, an HIV integrase inhibitor currently in development by GlaxoSmithKline as a long acting parenteral drug.
• the "third compound” is Rilpivirine, 4-[[4-[[4-(2-Cyanoethenyl)-2,6- dimethylphenyl]amino]-2- pyrimidinyl]amino]benzonitrile, which is a non-nucleoside reverse transcriptase inhibitor (NNRTI) of human immunodeficiency virus type 1 (HIV-1 ) and indicated for the treatment of HIV-1 infection in treatment-naive adult patients in combination with other antiretroviral agents.
• NRTI non-nucleoside reverse transcriptase inhibitor
• HV-1 human immunodeficiency virus type 1
• Rilpivirine hydrochloride was launched as film coated tablets in Europe and the US (brand name Edurant).
• One of skill in the art will understand how to make Rilpivirine from one or more of the following US Patent Nos. 6838464, 7067522, 7125879, 7638522, 8080551 , and 8101629, all of
• HAART or highly active antiretroviral therapy consisting of at least three antiretroviral drugs, may fail following the development of viral resistance.
• Factors contributing to the incomplete suppression of HIV and to the development of resistance include insufficient drug potency, non-compliance, restricted tissue penetration, drug resistance and several host factors, such as host genetics.
• compliance during a life-long treatment is crucial, as establishing minimal inhibitory drug concentrations in the blood inhibits viral growth and the development of resistant strains.
• the present invention addresses such problematic issues in the treatment or prevention of HIV by formulating the first compound, second compound, and the optional third compound either each one separately or two or three of them together as a long-acting parenteral (LAP) composition or depot formulation suitable for administration, for example, once per week, once every two weeks, once per month, once every 2 months, once every 3 months, once every 6 months or once every 12 months.
• LAP parenteral
• compositions comprising an active ingredient which is the first and second compound and optional third compound, or pharmaceutically acceptable salts thereof, suitable for administration once monthly or longer.
• the present invention features pharmaceutical
• compositions comprising the first compound, second compound, and/or third compound, or pharmaceutically acceptable salt thereof, and a surfactant system.
• the present invention features a pharmaceutical composition, comprising a therapeutically effective amount of first and second compound and optional third compound, or pharmaceutically acceptable salts thereof, and a surfactant system.
• the term "therapeutically effective amount,” as used herein, means a sufficient amount of a drug, compound, composition, product or pharmaceutical agent to abate or reverse or treat a malady in a human or other mammal.
• the present invention features parenteral pharmaceutical compositions for administration to a subject, for example a human.
• the present invention features long-acting parenteral pharmaceutical compositions comprising the first and second compound and optional third compound, or pharmaceutically acceptable salts thereof, and a surfactant system for weekly (once every week) administration.
• the present invention features long-acting parenteral pharmaceutical compositions comprising the first and second compound and optional third compound, or a pharmaceutically acceptable salt thereof, and a surfactant system for biweekly (once every two weeks) administration.
• the present invention features long-acting parenteral pharmaceutical compositions comprising the first and second compound and optional third compound, or a pharmaceutically acceptable salt thereof, and a surfactant system for once monthly administration.
• the present invention features long-acting parenteral pharmaceutical compositions comprising the first and second compound and optional third compound, or a pharmaceutically acceptable salt thereof, and a surfactant system for bimonthly (once every two months) administration.
• the present invention features long-acting parenteral pharmaceutical compositions comprising the first and second compound and optional third compound, or a pharmaceutically acceptable salt thereof, and a surfactant system for tri- monthly (once every three months) administration.
• the present invention features long-acting parenteral pharmaceutical compositions comprising the first and second compound and optional third compound, or a pharmaceutically acceptable salt thereof, and a surfactant system
• compositions of the present invention provide for the slow release of the first and second compound and optional third compound, over an extended period of time within the body of a subject. Therefore, in order to achieve therapeutic levels of drug, the first and second compound and optional third compound, advantageously is released from the composition within approximately one to three months, or any time point within this range.
• An embodiment of the present invention is a pharmaceutical composition suitable for parenteral administration comprising the first and second compound and optional third compound, and a surfactant system comprising a combination of polymers providing for the release of the first and second compound and optional third compound, over a period of one week to three months.
• a suitable combination of polymers is, for example, polysorbate 80 and polyvinylpyrrolidone (PVP).
• compositions of the present invention may be administered to the subject by various routes, including intramuscular (IM), intravenous (IV), or subcutaneous (SQ). Therefore, in one embodiment, the compositions of the present invention are administered to a subject by an intramuscular route. In another embodiment, the compositions of the present invention are administered to a subject by an intravenous route. In another embodiment, the compositions of the present invention are administered to a subject by a subcutaneous route.
• IM intramuscular
• IV intravenous
• SQ subcutaneous
• a surfactant system means any formulation suitable for pharmaceutical purposes that includes at least one surfactant.
• a surfactant system that can be used with the present invention may include, in addition to a surfactant, additional components such as buffers, polymers (for drug particles), wetting agents, stabilizers, tonicity modifiers, and solvents such as water.
• the surfactant system may include any surfactant as long as it is compatible with pharmaceutical applications.
• suitable surfactants include, but are not limited to, polyoxyethylene sorbitan fatty acid esters (polysorbates such as polysorbate 20 or 80), poloxamers (such as LUTROLTM F68, F108 and F127 which are block copolymers of ethylene oxide and propylene oxide, sodium dodecylsulfate and/or sodium lauryl sulphate), sorbitan esters of fatty acids (SPAN), polyethoxylated castor oil and its derivatives, tocopheryl polyethylene glycol succinate, and polyvinyl alcohols.
• polyoxyethylene sorbitan fatty acid esters polysorbates such as polysorbate 20 or 80
• poloxamers such as LUTROLTM F68, F108 and F127 which are block copolymers of ethylene oxide and propylene oxide, sodium dodecylsulfate and/or sodium lauryl sulphate
• the surfactant system comprises an amount of surfactant that ranges from about 0.01 % (w/v) to about 5% (w/v) surfactant. In other embodiments, the surfactant system comprises an amount of surfactant that ranges from about 0.1 % (w/v) to about 3% (w/v) surfactant. In still other embodiments, the surfactant system comprises about 0.2% (w/v) surfactant. In still other embodiments, the surfactant system comprises about 0.4% (w/v) surfactant. In other embodiments, the surfactant system comprises polysorbate-80 (e.g., Tween-80). In still other embodiments, the surfactant system comprises 0.4% (w/v) polysorbate-80.
• Representative stabilizers include, but are not limited to, polyethylene glycols, carboxymethylcellulose calcium, carboxymethylcellulose sodium, methylcellulose, hydroxyethylcellulose, hydroxypropylcellulose, hydroxymethylpropylcellulose,
• the surfactant system comprises an amount of stabilizer that ranges from about 0.01 % (w/v) to about 5% (w/v) stabilizer. In other embodiments, the surfactant system comprises an amount of stabilizer that ranges from about 1 % (w/v) to about 5% (w/v) stabilizer. In other embodiments, the surfactant system comprises an amount of stabilizer that ranges from about 1 % (w/v) to about 3% (w/v) stabilizer. In still other embodiments, the surfactant system comprises about 2% (w/v) stabilizer. In other embodiments, the surfactant system comprises polyethylene glycols. In other embodiments, the surfactant system comprises PEG-3350. In still other embodiments, the surfactant system comprises 2% (w/v) PEG-3350.
• Suitable buffer salts include, but are not limited to, buffer salts selected from phosphate salts, citrate salts, acetate salts, and tartrate salts, etc.
• the surfactant system comprises an amount of buffer salts that ranges from about 1 mM to about 100mM buffer salt. In other embodiments, the surfactant system comprises an amount of buffer salts that ranges from about 2mM to about 50mM buffer salt. In other embodiments, the surfactant system comprises an amount of buffer salts that ranges from about 3mM to about 25mM buffer salt. In other embodiments, the surfactant system comprises an amount of buffer salts that ranges from about 5mM to about 15mM buffer salt.
• the surfactant system comprises about 10mM buffer salt.
• the pH of the buffer salt is adjusted to range from about pH 6.0 to about pH 8.0. In other embodiments, the pH of the buffer salt is adjusted to range from about pH 6.5 to about pH 7.5. In other embodiments, the pH of the buffer salt is adjusted to range from about pH 6.7 to about pH 7.3.
• the buffer salt comprises phosphate buffered saline (PBS). In another embodiment, the buffer salt comprises phosphate buffered saline at a concentration of about 10mM. In another embodiment, the buffer salt comprises phosphate buffered saline at a concentration of about 10 mM and a pH of about 6.9.
• Suitable tonicity modifiers include, but are not limited to, sodium chloride, mannitol, sucrose, maltose, and dextrose, etc.
• the tonicity modifier comprises sodium chloride.
• the tonicity modifier is sodium chloride.
• the surfactant system comprises a concentration of tonicity modifier that ranges from about 0 to about 350 mM.
• the surfactant system comprises a concentration of tonicity modifier that ranges from about 0 to about 175 mM.
• the surfactant system has a tonicity that ranges from about 250 to about 350 mOsmol/kg.
• the first and second compound and optional third compound can be suspended as micro particles in a surfactant system and aqueous buffer.
• the first compound can be in an amorphous form or in a crystalline form.
• the drug particle size (D 50 ) will range from about 0.05 ⁇ to about 100 ⁇ . In other embodiments, the drug particle size will range from about 0.1 ⁇ to about 50 ⁇ . In other embodiments, the drug particle size will range from about 0.1 ⁇ to about 20 ⁇ . In other embodiments, the drug particle size (D 50 ) will range from about 0.1 ⁇ to about 10 ⁇ . In other embodiments, the drug particle size (D 50 ) will range from about 0.1 ⁇ to about 5 ⁇ .
• the drug particle size (D 50 ) will range from about 1 ⁇ to about 5 ⁇ . In other embodiments, the drug particle size (D 50 ) will range from about 0.05 ⁇ to about 0.05 ⁇ . In other embodiments, the drug particle size (D 50 ) will range from about 0.5 ⁇ to about 5 ⁇ . In other embodiments, the drug particle size (D 50 ) will range from about 5 ⁇ to about 25 ⁇ . In other embodiments, the drug particle size (D 50 ) will range from about 25 ⁇ to about 100 ⁇ .
• the drug particle size in the surfactant system can be mixed sizes.
• having substantially different particle sizes from relatively large to relatively small can achieve acceptable pharmacokinetic parameters for the formulation because the small particles are absorbed and metabolized quicker than the larger particles.
• This type of mixed particle size formulation could enhance the long acting nature of the present invention by providing a quicker release of drug to the subject early after
• the present LAP invention could comprise two or more substantially different particle sizes that would allow for earlier and later release of the first compound and second compound and optional third compound and such differing absorption kinetics would be a means of enhancing a durable long acting drug exposure.
• the first compound is in a microparticle form, wherein the microparticles of the first compound range in size from about 0.05 ⁇ to about 100 ⁇ , wherein said microparticles comprise two or more substantially different particle sizes.
• the drug particles of the first and second compound and optional third compound are encapsulated into polymer based microparticles that can, optionally, be subsequently freeze dried for extended storage.
• encapsulated is used with regards to the present invention, it is meant that the first and second compound and optional third compound is substantially surrounded by a polymer even though some compound may still be present on the surface of the encapsulated compound/polymer structure.
• the dry microparticles can optionally suspended in an aqueous buffer solution.
• the polymers used to prepare such microparticles can be selected from a series of biodegradable polymers including poly (lactic-co-glycolic) acid (M w 5-200 kD) and its derivatives, such as polyethylene glycol based amphiphilic polymers, etc.
• the microparticle size (D 50 ) could range from about 1 ⁇ to about 100 ⁇ and the drug encapsulation could range from about 10% to about 70% (w/w). In one
• the drug particles of the first and second compound and optional third compound are encapsulated into polymer based microparticles such as those containing ResomerTM.
• the drug particles of the first and second compound and optional third compound are encapsulated into polymer based microparticles such as those containing ResomerTM 752S.
• in-situ gels could be used to encapsulate the first compound.
• This could be a water-miscible organic solvent-based solution that contains both the first compound and a gel-forming polymer that is water-insoluble. Once administrated (IM or SC), the organic solvent dissipates away and the water-insoluble polymer precipitates out to form the gel containing the first compound. The the first compound would then slowly diffuse out as the polymer-based gel degrades in body.
• the polymers used to prepare in-situ gels are selected from a series biodegradable polymers including poly (lactic-co-glycolic) acid (M w 5-200 kD) and its derivatives, polyethylene glycol based amphiphilic polymers, etc.
• the organic solvents are selected from N-methyl pyrrolidone (NMP), dimethylsulfoxide (DMSO), dimethylformamide (DMF), dimethylacetamie (DMA), etc.
• NMP N-methyl pyrrolidone
• DMSO dimethylsulfoxide
• DMF dimethylformamide
• DMA dimethylacetamie
• the microparticle formulation can be made through spray-drying process.
• the organic solution containing both the first compound and the selected polymer prepared as described herein is subjected to a spray-drying process where the organic solvent is rapidly evaporated under nitrogen gas flow to form the first and second compound and optional third compound encapsulated microparticles.
• the drying temperature is no less than 35C and the solution spray rate is no less than 0.1 ml/min.
• the first compound and the selected polymer could be co-dissolved into the suitable organic solvent wherein the organic solvent must meet the following critieria: a) has a good solubility for the selected polymer; b) has a good miscibility with aqueous solution; and c) has a low toxicity and demonstrated safety when use in human; for example N-methyl pyrrolidone (NMP), dimethylsulfoxide (DMSO), dimethylformamide (DMF), dimethylacetamie (DMA), etc.
• NMP N-methyl pyrrolidone
• DMSO dimethylsulfoxide
• DMF dimethylformamide
• DMA dimethylacetamie
• the resulted solution containing both the first compound and selected polymer can be formulated by varying the polymer concentration, the polymer to the first compound ratio in the solvent so as to control the gel forming rate after administration and the subsequent drug diffusion rate.
• the solution finally is subjected to a terminal sterilization by ⁇ -irradiation on dry ice at a minimum dose of 25 kGy.
• An example of a combination of polymers includes a polysorbate, for example, polysorbate 80 as wetting agent and a polyvinylpyrrolidone (PVP), for example, Plasdone K29/32 as a stabilizer. Therefore, in one embodiment, the present invention features a parenteral pharmaceutical composition comprising a first and second compound and optional third compound, or pharmaceutically acceptable salts thereof, and polysorbate 80 and the polyvinylpyrrolidone: Plasdone K29/32.
• PVP polyvinylpyrrolidone
• An embodiment of the present invention is a pharmaceutical composition for parenteral administration comprising the first and second compound and optional third compound, and a surfactant system suitable for commonly known sterilization technologies such as gamma irradiation, electron beam irradiation and autoclave sterilization.
• An embodiment of the present invention is a pharmaceutical composition for parenteral administration comprising the first and second compound and optional third compound, and a surfactant system that can be manufactured using aseptic technique.
• An embodiment of the present invention is a pharmaceutical composition for parenteral administration comprising the first and second compound and optional third compound, and a surfactant system suitable for gamma radiation sterilization.
• An embodiment of the present invention is a pharmaceutical composition for parenteral administration comprising the first and second compound and optional third compound, and a surfactant system suitable for sterilization technologies by electron beam irradiation or autoclave sterilization.
• An embodiment of the present invention is a pharmaceutical composition for parenteral administration that can be presented as a "ready to use” sterile suspension or lyophile for reconstitution.
• compositions of the present invention may be administered by:
• compositions of the present invention may also be administered by intradermal or intravitreal injection or implant.
• compositions of the present invention may also be administered by other parenteral routes of administration.
• compositions of the present invention may be performed by milling using a wet bead mill and sterilized by gamma irradiation.
• Another feature of the present invention is to simplify treatment regimens for
• HIV with the goal of enhancing patient compliance by providing a simplified dosage form containing therapeutically effective amounts of the first and second compound and optional third compound, or a pharmaceutically acceptable salt thereof.
• the present invention also features a method for treating HIV infections in a human, which method comprises administering to said human a composition according to the invention.
• the present invention features the use of a pharmaceutical composition according to the invention in the treatment of HIV infections.
• the present invention features the manufacture of a medicament according to the invention for use in medical therapy.
• the present invention features the manufacture of a medicament according to the invention for use in the treatment of HIV infection.
• the present invention also features a method for treating HIV infections in a human which method comprises administering to said human a composition according to the invention before, during, or after therapy with the first and second compound and optional third compound, in tablet or solution form.
• treatment extends to treatment of an established malady, infection or symptoms thereof.
• the present invention also features a method for preventing HIV infections in a human, which method comprises administering to said human a composition according to the invention.
• the present invention features the use of a pharmaceutical composition according to the invention in the prevention of HIV infections.
• the present invention features the manufacture of a medicament according to the invention for use in prophylactic medical therapy.
• the present invention features the manufacture of a medicament according to the invention for use in preventing HIV infection.
• the present invention also features a method for treating or preventing HIV infections in a human which method comprises administering to said human a composition according to the invention before, during, or after therapy with the first and second compound and optional third compound, in tablet or solution form.
• a pharmaceutical composition comprising a therapeutically effective amount of a long acting formulation com rising a first compound of the structure:
• second compound of the structure:
• a pharmaceutical composition comprising the first and second compound and optional third compound, which are formulated for subcutaneous administration.
• composition comprising the first and second compound and optional third compound, which are formulated for intramuscular administration.
• a pharmaceutical composition comprising the first and second compound and optional third compound, which are formulated for administration once weekly or longer.
• a pharmaceutical composition comprising the first and second compound and optional third compound, which are formulated for administration once weekly.
• a pharmaceutical composition comprising the first and second compound and optional third compound, which are formulated for administration once per month.
• a pharmaceutical composition comprising the first and second compound and optional third compound, which are formulated for administration once every two months. In other embodiments, there is provided a pharmaceutical composition comprising the first and second compound and optional third compound, which are formulated for administration once every three months. In other embodiments, there is provided a pharmaceutical composition comprising the first and second compound and optional third compound, which are formulated for administration at any interval between 30 and 365 days.
• a pharmaceutical composition comprising the first compound and second compound and optional third compound, wherein the compounds are present in the compostion in the form of crystalline nanoparticles.
• a pharmaceutical composition comprising the first compound and second compound and optional third compound, wherein the compounds are present in the compostion in the form of matrix release particles.
• composition comprising the first compound and second compound and optional third compound, wherein the composition can be terminally sterilized by gamma irradiation.
• a method for the treatment of an HIV infection in a human having an HIV infection comprising administering to the human a single treatment pharmaceutical composition comprising a therapeutically effective amount of a long acting formulation comprising the first and second compound and optional third compound, or pharmaceutically acceptable salts thereof, in a pharmaceutically acceptable carrier for parenteral administration.
• a method for the prevention of an HIV infection in a human comprising administering to a human at risk of acquiring an HIV infection, a single treatment pharmaceutical composition comprising a therapeutically effective amount of a long acting formulation comprising the first compound and second compound and optional third compound, or pharmaceutically acceptable salts thereof, in a pharmaceutically acceptable carrier for parenteral administration.
• a LAP pharmaceutical composition comprising: the first compound, second compound, and/or third compound, or
• a method for the treatment of an HIV infection in a human having an HIV infection comprising: administering to the human a LAP pharmaceutical composition including the first compound, second compound, and/or third compound, or pharmaceutically acceptable salts thereof.
• a method for the prevention of an HIV infection in a human having an HIV infection comprising: administering to the human a LAP pharmaceutical composition including the first compound, second compound, and/or third compound, or pharmaceutically acceptable salts thereof.
• a LAP pharmaceutical composition comprising: the first compound and second compound and/or third compound, or
• a LAP pharmaceutical composition comprising: the first compound and second compound and/or optional third compound or a pharmaceutically acceptable salt thereof, further comprising a surfactant system, wherein the surfactant system comprises a surfactant in an amount ranging from about 0.1 % (w/v) to about 3% (w/v) surfactant, or an amount ranging from 0.2% (w/v) to about 0.4% (w/v) surfactant, or the surfactant system comprises about 0.4% (w/v) surfactant.
• a LAP pharmaceutical composition comprising: the first compound and second compound and/or optional third compound in combination with one or more additional compounds selected from the group consisting of dolutegravir and ritonavir, or a pharmaceutically acceptable salt thereof.
• a method for the treatment of an HIV infection in a human having an HIV infection comprising: administering to the human a LAP pharmaceutical composition including the first compound and second compound and/or optional third compound, or pharmaceutically acceptable salts thereof, in combination with one or more additional compounds selected from the group consisting of dolutegravir and ritonavir, or a pharmaceutically acceptable salt thereof.
• a LAP pharmaceutical composition comprising: the first compound and second compound and/or optional third compound, or pharmaceutically acceptable salts thereof, in combination with any boosting agent, such as, ritonavir.
• the boosting agent could be dosed simultanteously as the first compound in the same IV or SC syringe, or it could be dosed separately as an oral tablet or capsule.
• the LAP composition comprising the first compound and second compound and/or optional third compound are administered to the subject only after the subject has been administered treatment comprising a generally accepted antiretroviral (ARV) regimen.
• An initial ARV regimen generally consists of two NRTIs in combination with an NNRTI, a PI (preferably boosted with ritonavir [RTV]), an INSTI, or a CCR5 antagonist (namely maraviroc [MVC]).
• NNRTI-, PI-, INSTI-, or CCR5 antagonist-based regimens have all resulted in HIV RNA decreases and CD4 cell increases in a large majority of patients.
• one generally accepted ARV regimen comprises could be selected from any of the following for antiretroviral (ARV)-naive patients: efavirenz/tenofovir disoproxil fumarate/emtricitabine (EFV/TDF/FTC) ritonavir-boosted atazanavir + tenofovir disoproxil fumarate/emtricitabine (ATV/r + TDF/FTC) ritonavir-boosted darunavir + tenofovir disoproxil fumarate/emtricitabine (DRV/r + TDF/FTC) raltegravir + tenofovir disoproxil fumarate/emtricitabine (RAL + TDF/FTC) [0089]
• the pharmaceutical compositions of the invention are presented as pharmaceutical compositions suitable for parenteral administration.
• the compositions may also include a safe and effective amount of other active ingredients, such as antimicrobial agents, antiviral agents, or preservatives.
• compositions of the present invention enable patients greater freedom from multiple dosage regimens and ease the needed diligence required in remembering complex daily dosing times and schedules.
• the compositions of the present invention are particularly suitable for administration as a single dose monthly, bi-monthly or tri-monthly, or at any interval between 30 and 365 days, including every six or twelve months.
• compositions of the present invention may be any compositions of the present invention.
• compositions of the present invention may be used in combination with other pharmaceutical formulations as a component of a multiple drug treatment regimen. Such combinations could be administered to a subject in one dosage unit, such as a fixed dose combination or it could be administered in separate dosage units.
• compositions of the present invention may also be packaged as articles of manufacture comprising a therapeutically effective amount of a compound of formula (I), or a pharmaceutically acceptable salt thereof; and therapeutically effective amount of one or more of the following: nucleoside reverse transcriptase inhibitor, non-nucleoside reverse transcriptase inhibitor, protease inhibitor, and integrase inhibitor.
• the packaging material may also have labelling and information related to the pharmaceutical composition printed thereon. Additionally, an article of manufacture may contain a brochure, report, notice, pamphlet, or leaflet containing product information. This form of pharmaceutical information is referred to in the pharmaceutical industry as a
• a package insert may be attached to or included with a pharmaceutical article of manufacture.
• the package insert and any article of manufacture labelling provides information relating to the pharmaceutical composition.
• the information and labelling provides various forms of information utilized by health-care professionals and patients, describing the composition, its dosage and various other parameters required by regulatory agencies such as the United States Food and Drug Agencies.
• the present invention further provides the following embodiments: (a) A parenteral pharmaceutical composition comprising an effective amount of the first and second compounds and/or optional third compound, or pharmaceutically acceptable salts thereof, for the long term treatment of HIV infection, or prevention of HIV infection in an individual at risk of being infected by HIV, wherein the composition is administered intermittently at a time interval of at least one week.
• composition according to (b) The composition according to (a) wherein the composition is administered once every two weeks.
• composition according to (c) The composition according to (a) wherein the composition is administered once every month.
• composition according to any one of (a) to (c) wherein the effective amount of each of the first and second compounds and/or optional third compound, or
• the blood plasma concentration of the first and second compounds and/or optional third compound, in a subject is kept during a prolonged period of time at a level between a maximum blood plasma level which is the blood plasma level that causes significant side effects and the minimum blood plasma level that is the lowest blood plasma level that causes the first and second compound and optional third compound, to provide effective treatment or prevention of HIV infection.
• composition according to (d) wherein the blood plasma level of a subject is kept at a level equal to or above about 150 ng/ml, in particular equal to or above about 600 ng/ml.
• composition according to any one of (a) to (e), wherein the composition is administered subcutaneously or intramuscularly.
• aforementioned surfactant system comprising polysorbate and /or polyvinylpyrrolidone.
• the dose of the administered first and second compound and optional third ompound which is the amount of the compounds in the parenteral composition for use in the invention, may be selected such that the blood plasma concentration of the compounds in a subject is kept during a prolonged period of time above a minimum blood plasma level.
• minimum blood plasma level (or C min. ) in this context refers to the lowest efficacious blood plasma level, that is, the blood plasma level of the compounds that provides effective prevention or treatment HIV infection. In the case of transmission of HIV from an individual infected by HIV to an individual not infected by HIV, this is the lowest blood plasma level that is effective in inhibiting said transmission.
• the blood plasma level of the LAP formulations comprising the first and second compounds and optional third compound in a subject may be kept at a level above a minimum blood plasma level of about 170 ng/ml, about 700 ng/ml, or about 1000 ng/ml.
• the blood plasma levels of the compounds in a subject may be kept above these minimum blood plasma levels because at lower levels the drug may no longer be effective, thereby increasing the risk of transmission of HIV infection, and may be suboptimal for treatment of HIV infected subjects.
• Plasma levels of the compounds may be kept at higher levels to avoid the development of HIV mutations, while maintaining a safety margin.
• An advantage of the mode of administration of the LAP formulations comprising the first and second compound and (I) is that high C min levels can be achieved without a commensurate high C max , which could mitigate potential side effects associated
• the effective amount of the first and second compounds and optional third compound to be administered may be selected such that the blood plasma concentrations in a subject are kept during a prolonged period of time at a level between a maximum plasma level (or C max ) and the minimum blood plasma level (or C min ).
• the blood plasma level of the compounds in a subject may be kept between the minimum blood plasma level (or C min as specified above) and the lower maximum plasma level of compound (I) (or C max ) which is defined as the level that corresponds to the lowest blood plasma level where the compounds act therapeutically.
• the lowest level where the compounds act therapeutically is the lowest blood plasma level that is effective in inhibiting replication of HIV in individuals infected by HIV so that the viral load of HIV is relatively low, for example where the viral load (represented as the number of copies of viral RNA in a specified volume of serum) is below about 200 copies/ml, in particular below about 100 copies/ml, more particularly below 50 copies/ml, specifically below the detection limit of the assay for HIV.
• the blood plasma levels of the compounds depend on the amount of active ingredient in each parenteral dosage administered. However, it also depends on the frequency of the administrations (i.e. the time interval between each administration). Both parameters can be used to direct the blood plasma levels to the desired values. The dose may be higher where administrations are less frequent.
• the plasma levels of the compounds should remain below a maximum or above a minimum value, they may surpass the maximal value or drop below the minimal value during relatively short periods of time, which may be as short as possible.
• the maximum and minimum plasma levels therefore can be expressed as mean plasma levels during a certain period of time.
• compositions of the present invention conveniently allow administration of the first and second compound and optional third compound in unit dosage form containing, for example, from about 1 mg to about 1000 mg, from about 20 mg to about 100 mg, from about 20 mg to about 300 mg, from about 25 mg to about 800 mg, from about 25 mg to about 100 mg, from about 100 mg to about 200 mg, from about 200 mg to about 400 mg, from about 100 mg to about 800 mg, from about 100 mg to about 600 mg, from about 100 mg to about 400 mg per unit dosage form, or from about 400 mg to about 800 mg.
• the unit dose is from about 100 mg to about 200 mg, which is administered to the subject once every month. In some embodiments, there could be an initially loading dose that is substantially higher than the later maintenance dose.
• the first compound is administered initially to the subject as a loading dose in amount that ranges from 400 mg to 800 mg and then is administered as a maintenance dose thereafter in an amount that ranges from about 20 mg to about 300 mg.
• the subject could be dosed initially with 800 mg, then dosed at 100 mg thereafter.
• the unit dose concentration of the first and second compound and optional third compound in the formulation may be selected from any of the following ranges: 0.05 - 0.5 ⁇ , 0.5 to 1 ⁇ , 1-5 ⁇ , 5-25 ⁇ , 25-50 ⁇ , or 50-150 ⁇ .
• the dose to be administered may be calculated on a basis of about 1 mg/day to about 50 mg/day, preferably 3 mg/day to about 30 mg/day. This corresponds to a weekly dose of about 7 mg to about 350 mg, preferably about 20 mg to about 200 mg, or to a monthly dose of about 30 mg to about 1500 mg, preferably about 90 mg to about 900 mg. Doses for other dosing regimens can readily be calculated by multiplying the daily dose with the number of days between each administration.
• the dose to be administered may be calculated on a basis of about
• steady state is meant the condition in which the amount of drug present in the blood plasma of a subject stays at more or less the same level over a prolonged period of time.
• the plasma levels of the first and second compounds and optional third compound may then gradually decrease over time, and when the minimum plasma level is reached, then the next dose of first and second compounds and optional third compound may be administered.
• stays at more or less the same level does not exclude that there can be small fluctuations of the plasma concentrations within an acceptable range, for example, within about 30%, about 20%, or about 10%.
• compositions of the first and second compounds and optional third compound may be administered by intravenous injection or, preferably by subcutaneous or intramuscular administration.
• the present invention is based on the use of parenteral compositions of the active ingredients comprising the first and second compounds and optional third compound and therefore the nature of the carrier is selected for suitability for parenteral administration.
• the carrier in most cases will comprise sterile water, in although other ingredients, for example, to aid solubility, may be included.
• injectable solutions or suspensions for example, may be prepared in which the carrier comprises saline solution, glucose solution or a mixture of saline and glucose solution.
• the carrier may contain the surfactant system mentioned above such as polysorbate and polyethyleneglycol.
• the parenteral pharmaceutical composition comprising the first and second compounds and optional third compound of the present invention is long-acting. Accordingly, the composition is useful for the treatment or prevention of HIV infection with administration at long time intervals, compared with conventional compositions or with other compounds similar to the first and second compounds and optional third compound in chemical structure.
• the compositions of the present invention can be intermittently administered to a patient, e.g., once per week, once per month, once per every 2 months, or one per every 3 months.
• the compositions of the present invention could be administered at higher dosages (e.g., 800 mg) as a "loading dose" for the first one to three months, while after the first one to months the dosage could be lowered.
• compositions of the present invention and an administration by subcutaneous (SC) or intramuscular (IM) injection using the same can lead to a remarkable reduction in medication (pill) burden or difficulty in patient compliance. Further, such intermittent administration of a composition of the present invention can contribute
• the first compound formulation is a liquid suspension form for a bolus intramuscular or subcutaneous administration at a concentration ranges from 10 mg/ml to 250 mg/ml and having an injection volume of up to 4 ml (e.g., 2 injections, each 2 ml).
• the first compound may be synthesized by one of skill in the art by following the teachings of PCT Published Application No. WO WO2013090664 deriving from US Provisional Application 61/576448, filed December 16, 2011 which disclose a class of compounds useful in the treatment of HIV infection and AIDS.
• a Thermo Orion 9110DJWP microelectrode and a Metrohmn 827 pH Meter were used for pH measurements.
• An Advanced Micro-Osmometer 3320 was used for osmolarity measurements.
• a Retsch PM400 planetary mill was used for wet bead milling.
• the solution was filtered through a 0.22 micrometer Corning filter.
• the resultant LAP vehicle was 1.7% w/v Plasdone K29/32 and 0.2% w/v Polysorbate 80 in phosphate buffer: 0.004M NaH 2 Po 4 and 0.006M Na 2 HP0 4 .
• the LAP Vehicle (as prepared in Example 1) was added to a weight of 10 grams thereby yielding a 100 mg/ml suspension.
• Beads were added at 4x suspension volume and the milling vessel was sealed with security tape. Milling was started at 250 rpm for 3 hours using a planetary mill PM400 with a 15 minute interval. After 3 hours the milling vessel was left in the planetary mill overnight at ambient room temperature. The beads were filtered using a 25 mm Easy pressure Syringe Filter Holder (screen size:149 micrometers).
• WBM wet bead milled
• Example 3(a) [00130] 0.426 g of WBM suspension of Example 3(a) was added to a clear 5 ml sterile vial with a crimp cap.
• the LAP Vehicle (as prepared in Example 1) was added to a weight of 2 grams. The contents were swirled to mix. The resulting title solution had a pH of 6.87. The solution was utilized for 5 mg/kg IM injections.
• Example 3(a) 0.266 g of WBM suspension of Example 3(a) was added to a clear 10 ml sterile vial with a crimp cap.
• the LAP Vehicle (as prepared in Example 1) was added to a weight of 5 grams. The contents were swirled to mix. The resulting title solution had a pH of 6.78. The solution was utilized for 5 mg/kg SQ injections.
• the drug (the first compound) is either directly suspended into the aqueous buffer solution, or firstly milled by air milling into a more desirable particle size then followed by the suspension.
• the suspension was prepared by weighing the drug and the buffer solution
• the drug is firstly suspended into the buffer solution as stated above, then subjected to bead milling or microfluidization process in order to reduce the particle size to the submicron range. The prepared suspension is then subjected to a terminal sterilization by ⁇ -irradiation at a minimum dose of 25 kGy.
• the drug (the first compound) and selected encapsulating polymer were co-dissolved in a suitable organic solvent, wherein the organic solvent met the following criteria: a) had a good solubility for the first compound and the selected polymer, b) was not miscible with water; c) had a low boiling point, thus a good volatility.
• suitable organic solvents are; for example, methylene chloride (used in this Example), chloroform, ethyl acetate, ethyl formate, etc.
• the solution was then mixed at a volume ratio 1 :2 to 1 : 100 with water containing 0.1-10% (w/v) surfactant selected from polyvinyl alcohol (PVA - 1 % PVA used in this Example), polyvinyl pyrrolidone (PVP), poloxamers, polysorbates, polyethoxylated castor oil, tocopheryl polyethylene glycol succinate, etc, to form a uniform emulsion.
• PVA - 1 % PVA used in this Example polyvinyl pyrrolidone (PVP), poloxamers, polysorbates, polyethoxylated castor oil, tocopheryl polyethylene glycol succinate, etc, to form a uniform emulsion.
• PVP polyvinyl pyrrolidone
• poloxamers poloxamers
• polysorbates polyethoxylated castor oil
• tocopheryl polyethylene glycol succinate etc
• the washed pellet was then resuspended by water for injection in a suitable container followed by freeze drying into powdery microparticles encapsulating the first compound.
• the microparticles were then finally subjected to a terminal sterilization by ⁇ -irradiation on dry ice at a minimum dose of 25 kGy.
• Micro particle A (Drug:Resomer 752S 1 : 1)
• Micro particle B (Drug:Resomer 752S 1 :2)
• the microparticle A (first compound:Resomer 752S 1 : 1) and B (first compound: Resomer 752S 1 :2) were mixed with 0.912 and 0.945 ml of vehicle, respectively, by vortexing until a visually uniform suspension was obtained with no large agglomerates.
• the drug suspension was already formulated as a uniform 1 ml suspension and was re-suspended by vortexing until a visually uniform suspension was obtained with no large agglomerates.
• Three male Crl:CD rats per formulation were dosed and sampled for the intramuscular route of administration of the first compound.
• the intramuscular dose of the first compound was administered as a single dose of 20 mg/kg and at a dose volume of 0.5 ml/kg.
• Blood samples were collected at 0.5, 1 , 2, 4, 6, 8, 12, and 24 hours and up to 1680 hours post dose adminsitration. For each time point after dosing, approximately 0.1 ml blood samples were collected through tail-snip method, and

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